Clinically Isolated Syndrome (CIS)
Models used for illustrative purposes only.
Indications
BETASERON® (interferon beta-1b) is a prescription medicine used to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
What is CIS?
Clinically isolated syndrome (CIS) is a first episode of neurologic symptoms caused by inflammation in the central nervous system (CNS). The episode must last for at least 24 hours and is considered a relapsing form of multiple sclerosis (MS). In fact, CIS is often referred to as early MS.
Inflammation in the CNS happens when your body’s immune system mistakenly attacks and damages the protective coating around your nerves, which is called myelin. This damage prevents your nerves from sending signals to your brain, spinal cord, and other parts of your body the way they should.
What happens during a CIS episode?
The location where the damage to the myelin occurs in the CNS will determine what symptoms you might experience during a CIS episode. Damage can be in the spinal cord, optic nerve, or brain.
In the spinal cord, the onset of symptoms may be sudden, developing over 1 to 2 hours, or more gradual, happening over a week or more. Symptoms can include muscle weakness; abnormal sensations in the toes and feet; numbness or tingling in the arms, legs, or face; bladder and bowel problems; or Lhermitte’s sign (an electric shock-like sensation when the neck is moved that is felt down the spine, and often into the arms and legs).
In the optic nerve, the onset of symptoms may be sudden or develop over a few hours. Symptoms can include blurred vision or loss of sight, pain behind the eyeball, impaired color or blind spots surrounded by an area of normal vision or other eye problems.
When damage to the myelin occurs in the brain, symptoms may include nausea, vomiting, double vision, dizziness, hearing loss, or problems with balance or walking.
How is CIS diagnosed?
To make a diagnosis of CIS, your doctor—most likely a neurologist—may perform:
Occasionally, your doctor may perform a spinal tap to look at the fluid that surrounds your brain and spinal cord.
How is CIS treated?
In some cases, treatment with a high-dose oral or intravenous (IV) steroid is recommended to reduce symptoms caused by inflammation. Disease-modifying therapy (DMT) is recommended when CIS is considered more likely to progress. The goal of using DMT is to delay a second episode.
Early treatment may lessen the chance of the disease progressing because of additional damage to nerve cells. Beginning treatment with DMT as soon as possible is recommended for patients who have CIS and have MRI results consistent with more advanced types of relapsing MS.
What is the difference between CIS and RRMS?
Patients who experience CIS may or may not progress to other forms of relapsing MS. Relapsing-remitting multiple sclerosis (RRMS) is the most common form of relapsing MS (85% of patients).
In both CIS and RRMS, damage to the myelin interferes with the way the nerves and signals, which causes similar neurology symptoms. The main difference, however, is that a person with CIS has only experienced a first episode, while someone with RRMS has had more than one.
With CIS, MRI results may show damage in the area of the brain that is responsible for the current symptoms. In RRMS, the MRI scan may show multiple lesions (areas of damage) in different areas of the brain. When the MRI scan shows that another episode occurred in the past, the person may be diagnosed with RRMS.
Does CIS always progress?
Not all people who experience CIS will go on to develop RRMS. An MRI scan is one of the most important tools used to identify the risk of disease progressing. Studies have shown there is a high risk of developing RRMS when CIS is accompanied by brain lesions that are similar to those seen in other relapsing forms of MS. When this is the case, patients have a 60% to 80% chance of a second episode and diagnosis of RRMS within several years.
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INDICATIONS
BETASERON® (interferon beta-1b) is a prescription medicine used to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
IMPORTANT SAFETY INFORMATION
Do not take BETASERON (interferon beta-1b) if you are allergic to interferon beta-1b, to another interferon beta, to human albumin, or mannitol.
BETASERON can cause serious side effects, including:
Liver Problems Including Liver Failure. Symptoms of liver problems may include yellowing of your eyes, itchy skin, feeling very tired, flu-like symptoms, nausea or vomiting, bruising easily or bleeding problems. Your healthcare provider will do blood tests to check for these problems while you take BETASERON.
Serious Allergic Reactions. Serious allergic reactions can happen quickly and may happen after your first dose of BETASERON or after you have taken BETASERON many times. Symptoms may include difficulty breathing or swallowing, swelling of the mouth or tongue, rash, itching, or skin bumps.
Depression or Suicidal Thoughts. Call your healthcare provider right away if you have any of the following symptoms, especially if they are new, worse or worry you: thoughts about suicide or dying, new or worse depression (sinking feeling or sadness), new or worse anxiety (feeling uneasy, nervous or fearful for no reason), trouble sleeping (insomnia), acting aggressive, being angry, or violent, acting on dangerous impulses, hallucinations, other unusual changes in behavior or mood.
Other possible serious side effects with BETASERON include:
Heart Problems. BETASERON may worsen heart problems including congestive heart failure. Symptoms of heart problems may include swollen ankles, shortness of breath, decreased ability to exercise, fast heartbeat, tightness in chest, increased need to urinate at night, not being able to lay flat in bed.
Injection Site Problems. Serious skin reactions can happen in some people including areas of severe damage to skin and the tissue below the skin (necrosis). These reactions can happen anywhere you inject BETASERON. Symptoms of injection site problems may include swelling, redness, or pain at the injection site, fluid drainage from the injection site, and breaks in your skin or blue-black skin discoloration. Call your healthcare provider right away if an injection site becomes swollen and painful or the area looks infected. You may have a skin infection or an area of severe skin damage (necrosis) requiring treatment by a healthcare provider.
Pulmonary Arterial Hypertension. Pulmonary arterial hypertension can occur with interferon beta products, including BETASERON. Symptoms may include new or increasing fatigue or shortness of breath. Contact your healthcare provider right away if you develop these symptoms.
Flu-like Symptoms. BETASERON can cause flu-like symptoms including fever, chills, tiredness, sweating, muscle aches when you first start to use it. These symptoms may decrease over time. Taking medicines for fever and pain relief on the days you are using BETASERON may help decrease these symptoms.
Seizures. Some people have had seizures while taking BETASERON, including people who have never had seizures before. It is not known if the seizures were related to MS, to BETASERON, or to a combination of both. If you have a seizure after taking BETASERON call your healthcare provider right away.
Blood Problems. You may have a drop in the levels of infection-fighting white blood cells, red blood cells, or cells that help you form blood clots. If drops in levels are severe, they can lessen your ability to fight infections, make you feel tired or sluggish or cause you to bruise or bleed easily.
Pregnancy:
Tell your doctor if you are pregnant or plan to become pregnant.
Most Common Side Effects:
The most common side effects of BETASERON include low white blood cell count, increases in your liver enzymes, headache, increase in your muscle tension, pain, rash, problems sleeping, stomach pain, weakness. These are not all the possible side effects of BETASERON.
Tell your healthcare provider if you have any side effect that bothers you or that does not go away. Tell your healthcare provider about all the medicines you take and your medical conditions.
Please see the Full Prescribing Information and BETACONNECT™ Instructions for Use for additional information, and talk to your healthcare provider.
IMPORTANT SAFETY INFORMATION
Contraindications. BETASERON (interferon beta-1b) is contraindicated in patients with a history of hypersensitivity to natural or recombinant interferon beta, Albumin (Human), mannitol, or any other component of the formulation.
Hepatic Injury. Severe hepatic injury including cases of hepatic failure has been rarely reported in patients taking BETASERON. In some cases, these events have occurred in the presence of other drugs or comorbid medical conditions that have been associated with hepatic injury. Consider the potential risk of BETASERON used in combination with known hepatotoxic drugs or other products (e.g., alcohol) prior to BETASERON administration, or when adding new agents to the regimen of patients already on BETASERON. Monitor patients for signs and symptoms of hepatic injury. Consider discontinuing BETASERON if serum transaminase levels significantly increase, or if they are associated with clinical symptoms such as jaundice.
Asymptomatic elevation of serum transaminases is common in patients treated with BETASERON. In controlled clinical trials, elevations of SGPT to greater than five times baseline value were reported in 12% of patients receiving BETASERON (compared to 4% on placebo), and increases of SGOT to greater than five times baseline value were reported in 4% of patients receiving BETASERON (compared to 1% on placebo), leading to dose-reduction or discontinuation of treatment in some patients. Monitor liver function tests.
Anaphylaxis and Other Allergic-Reactions. Anaphylaxis has been reported as a rare complication of BETASERON use. Other allergic reactions have included dyspnea, bronchospasm, tongue edema, skin rash and urticaria.
Discontinue BETASERON if anaphylaxis occurs.
Depression and Suicide. Depression and suicide have been reported to occur with increased frequency in patients receiving interferon compounds, including BETASERON. Patients treated with BETASERON should be advised to report immediately any symptoms of depression and/or suicidal ideation. Consider discontinuation of BETASERON if depression occurs.
Congestive Heart Failure. Monitor patients with pre-existing congestive heart failure (CHF) for worsening of their cardiac condition during initiation of and continued treatment with BETASERON. Cases of CHF, cardiomyopathy, and cardiomyopathy with CHF have been reported in patients without known predisposition to these events, and without other known etiologies being established. In some cases, these events have been temporally related to the administration of BETASERON. Recurrence upon rechallenge was observed in some patients. Consider discontinuation of BETASERON if worsening of CHF occurs with no other etiology.
Injection Site Necrosis and Reactions. Injection site reactions occurred in 78% of BETASERON patients receiving BETASERON (compared to 26% on placebo) in controlled clinical trials with injection site necrosis reported in 4% of BETASERON patients (compared to 0% on placebo). For patients who continue BETASERON after injection site necrosis has occurred, BETASERON should not be administered into the affected area until it is fully healed. If multiple lesions occur, therapy should be discontinued until healing occurs. Patients should be advised of the importance of the use of aseptic technique and rotating injection sites.
Leukopenia. Leukopenia has been reported in 18% of patients receiving BETASERON (compared to 6% on placebo) in controlled clinical trials leading to a reduction in dose in some patients. Monitoring of complete blood and differential white blood cell counts is recommended. Patients with myelosuppression may require more intensive monitoring.
Thrombotic Microangiopathy. Cases of thrombotic microangiopathy (TMA), including thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, some fatal, have been reported several weeks to years after starting interferon beta products. Discontinue BETASERON if clinical symptoms and laboratory findings consistent with TMA occur, and manage as clinically indicated.
Flu-like Symptom Complex. Flu-like symptom complex for patients on BETASERON was 57% (versus 37% on placebo) in controlled clinical trials. Analgesics and/or antipyretics on treatment days may help ameliorate flu-like symptoms.
Seizures. Seizures have been temporally associated with the use of beta interferons.
Drug-induced Lupus Erythematosus. Drug-induced lupus erythematosus has been reported with interferon beta products, including BETASERON. Signs and symptoms of drug-induced lupus reported in BETASERON-treated patients have included rash, serositis, polyarthritis, nephritis, and Raynaud's phenomenon. Cases have occurred with positive serologic testing (positive anti-nuclear and/or anti-double-stranded DNA antibody testing). If patients develop new signs and symptoms of this syndrome, BETASERON therapy should be stopped.
Monitoring for Laboratory Abnormalities. In addition to those laboratory tests normally required for monitoring patients with multiple sclerosis, complete blood and differential white blood cell counts, platelet counts and blood chemistries including liver function tests are recommended at one, three and six months after introduction of BETASERON therapy, and periodically thereafter in the absence of clinical symptoms.
Most Common Adverse Reactions. The most commonly reported adverse reactions (at least 5% more frequent on BETASERON than on placebo) in controlled clinical trials were injection site reaction (78% vs 26% for placebo), lymphopenia (86% vs 66%), flu-like symptoms (57% vs 37%), myalgia (23% vs 14%), leukopenia (13% vs 4%), neutropenia (13% vs 5%), increased liver enzymes (SGPT to greater than five times baseline value [12% vs 4%], SGOT to greater than five times baseline value [4% vs 1%]), headache (50% vs 43%), hypertonia (40% vs 33%), pain (42% vs 35%), rash (21% vs 15%), insomnia (21% vs 16%), abdominal pain (16% vs 11%), and asthenia (53% vs 48%).
Please see the Full Prescribing Information and BETACONNECT™ Instructions for Use for additional information, and talk to your healthcare provider.
